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NPI Code Detail

MEDICARE: DR. AYESHA BAKIR ABDULLAH-EWING DDS

MEDICARE: DR. AYESHA BAKIR ABDULLAH-EWING DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry019027011IL

General Provider Information

NPI Number : 1255465001
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AYESHA BAKIR ABDULLAH-EWING DDS
Provider Business Mailing Address
First Line : 430 W ERIE ST
Second Line : STE. 500
City : CHICAGO
State : IL
Zip : 60610-6914
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3210 W 63RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60629-3325
Country : US
Telephone Number : 773-776-8300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2007
Last Update Date : 07/08/2007

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